Cystitis

Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, in which case it may be referred to as a urinary tract infection (UTI). A bladder infection can be painful and annoying, and can become a serious health problem if the infection spreads to your kidneys.

Less commonly, cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness.

The usual treatment for bacterial cystitis is antibiotics. Other treatments are used for other types of cystitis.

Types:
There are several types of cystitis:

Bacterial cystitis, the most common type, which is most often caused by coliform bacteria being transferred from the bowel through the urethra into the bladder.

Interstitial cystitis (IC) is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. However, there is hope. Several therapies are now available.

Eosinophilic cystitis, is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC is also unknown though it has been triggered in children by certain medications. Some consider it a form of interstitial cystitis.

Radiation cystitis, often occurs in patients undergoing radiation for the treatment of cancer.

Hemorrhagic cystitis.

Causes:
Your urinary system is composed of the kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Your kidneys — a pair of bean-shaped organs located toward the back of your upper abdomen — filter waste from your blood and adjust the body composition of many substances. Tubes called ureters carry urine from your kidneys to the bladder, where it's stored until it exits your body through the urethra.

Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria and becomes irritated and inflamed. It is very common.

The condition frequently affects sexually active women ages 20 to 50 but may also occur in those who are not sexually active or in young girls. Older adults are also at high risk for developing cystitis, with the incidence in the elderly being much higher than in younger people.

Cystitis is rare in males. Females are more prone to the development of cystitis because of their relatively shorter urethra—bacteria do not have to travel as far to enter the bladder—and because of the relatively short distance between the opening of the urethra and the anus. However it is not an exclusively female disease.

More than 85% of cases of cystitis are caused by Escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Sexual intercourse may increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results.

Risks for cystitis include obstruction of the bladder or urethra with resultant stagnation of urine, insertion of instruments into the urinary tract (such as catheterization or cystoscopy), pregnancy, diabetes, and a history of analgesic nephropathy or reflux nephropathy.

The elderly of both sexes are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility and placement in a nursing home are situations which put people at increased risk for cystitis.

Noninfectious cystitis
Although bacterial infections are the most common cause of cystitis, a number of other noninfectious factors may cause the bladder to become inflamed. Some examples:
Interstitial cystitis- The cause of this chronic bladder inflammation, also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.
Drug-induced cystitis- Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down substances of the drugs exit your body.
Radiation cystitis- Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.
Foreign-body cystitis- Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.
Chemical cystitis- Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.
Cystitis associated with other conditions- Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus and tuberculosis.

Symptoms:

Cystitis symptoms often include:

A strong, persistent urge to urinate, A burning sensation when urinating, Passing frequent, small amounts of urine, Blood in the urine (hematuria), Passing cloudy or strong-smelling urine, Discomfort in the pelvic area, A feeling of pressure in the lower abdomen, Low-grade fever, Pressure in the lower pelvis, Painful urination (dysuria), Need to urinate at night (nocturia, similar to prostate cancer or BPH), Blood in the urine (hematuria) (similar to a female's period or bladder cancer), Foul or strong urine odor, etc.

In young children, new episodes of bed-wetting (enuresis) also may be a sign of a UTI.

Diagnosis:
If you have symptoms of cystitis, talk to your doctor as soon as possible. In addition to discussing your signs and symptoms and your medical history, your doctor may order these tests, as well:

Urine analysis- If your doctor suspects you have a bladder infection, he or she may ask for a urine sample to determine whether bacteria, blood or pus is in your urine.
Cystoscopy- Inspection of your bladder with a cystoscope — a thin tube with a light and camera attached that can be inserted through the urethra into your bladder — may help with the diagnosis. Your doctor can also use the cystoscope to remove a small sample of tissue (biopsy) for analysis in the laboratory.
Imaging tests- Imaging tests usually aren't necessary but in some instances — especially when no evidence of infection is found — they may be helpful. Tests, such as X-ray or ultrasound, may help rule out other potential causes of bladder inflammation, such as a tumor or structural abnormality.

Treatment:
Antibiotics are used to control bacterial infection. It is vital that one finish an entire course of prescribed antibiotics. However, cystitis can also be treated with over-the-counter medicines, where self-treatment is appropriate.

Commonly used antibiotics include:
Nitrofurantoin, Trimethoprim-sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin or levofloxacin, Doxycycline, etc.

The choice of antibiotic should preferably be guided by the result of urine culture.

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may be required for long periods of time. Prophylactic low-dose antibiotics are sometimes recommended after acute symptoms have subsided.

Pyridium may be used to reduce the burning and urgency associated with cystitis. In addition, common substances that contain weak acids such as ascorbic acid or cranberry juice, act as weak buffers in the urine rendering it less acidic and thus reduce pain on urination. An effective, but old fashioned treatment (that seems to have been forgotten) is a salt water douche. Dissolve plenty of salt in warm water and bathe the affected region until symptoms subside.

Cystic fibrosis

Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease that affects mainly the exocrine (mucus) glands of the lungs, liver, pancreas, and intestines, causing progressive disability due to multisystem failure.

Thick mucus production, as well as a less competent immune system, results in frequent lung infections. Diminished secretion of pancreatic enzymes is the main cause of poor growth, fatty diarrhea and deficiency in fat-soluble vitamins. Males can be infertile due to the condition congenital bilateral absence of the vas deferens. Often, symptoms of CF appear in infancy and childhood. Meconium ileus is a typical finding in newborn babies with CF.

Individuals with cystic fibrosis can be diagnosed prior to birth by genetic testing. Newborn screening tests are increasingly common and effective. The diagnosis of CF may be confirmed if high levels of salt are found during a sweat test, although some false positives may occur.

There is no cure for CF, and most individuals with cystic fibrosis die young: many in their 20s and 30s from lung failure. However, with the continuous introduction of many new treatments, the life expectancy of a person with CF is increasing. Lung transplantation is often necessary as CF worsens.

Cystic fibrosis is one of the most common life-shortening, childhood-onset inherited diseases. In the United States, 1 in 3900 children are born with CF. It is most common among Europeans and Ashkenazi Jews; one in twenty-two people of European descent are carriers of one gene for CF, making it the most common genetic disease in these populations. Ireland has the highest rate of CF carriers in the world (1 in 19).

CF is caused by a mutation in a gene called the cystic fibrosis transmembrane conductance regulator (CFTR). The product of this gene is a chloride ion channel important in creating sweat, digestive juices, and mucus. Although most people without CF have two working copies of the CFTR gene, only one is needed to prevent cystic fibrosis. CF develops when neither gene can produce a functional CFTR protein. Therefore, CF is considered an autosomal recessive disease.

Causes:
In cystic fibrosis, a defective gene alters a protein that regulates the normal movement of salt (sodium chloride) in and out of cells. This results in thick, sticky secretions in the respiratory and digestive tracts, as well as in the reproductive system. It also causes increased salt in sweat.

The affected gene, which is inherited from a child's parents, is a recessive gene. With recessive genes, children need to inherit two copies of the gene, one from each parent, in order to have the disease. If children inherit only one copy, they won't develop cystic fibrosis, but will be carriers and possibly pass the gene to their own children.

If two people who carry the defective gene conceive a child, there's a 25 percent chance the child will have cystic fibrosis, a 50 percent chance the child will be a carrier of the cystic fibrosis gene, and a 25 percent chance the child will neither have the disease nor be a carrier.

People who carry the cystic fibrosis gene are healthy and have no symptoms — they may be carriers and not know it. Although parents often blame themselves when a child is born with cystic fibrosis, it's important to remember that the causes of cystic fibrosis are not the result of anything a parent consciously does.

The role of fatty acids
Some experts believe that an imbalance of essential fatty acids may play a role in cystic fibrosis. People with cystic fibrosis appear to have excessively high levels of arachidonic acid and a deficiency of another fatty acid, docosahexaenoic acid.

Healthy people who carry one cystic fibrosis gene have fatty acid levels midway between those of people with cystic fibrosis and people with no genetic mutations for the disease. But the exact nature of the relationship between fatty acid levels and the gene defect that causes cystic fibrosis isn't clear.

Symptoms:
The specific signs and symptoms of cystic fibrosis can vary with the severity of the disease. For example, one child with cystic fibrosis may have respiratory problems but not digestive problems, while another child may have both. In addition, the signs and symptoms of cystic fibrosis may vary with age.

Signs and symptoms in newborns
In some newborns, the first sign may be a blockage of their intestines (meconium ileus). This occurs when meconium — tarry, greenish-black stools normally passed by an infant during the first day or two after birth — becomes so thick it can't move through the intestines. Other signs in newborns may include:

* Failure to grow.
* Bulky and greasy stools (steatorrhea).
* Frequent respiratory infections.

Signs and symptoms in children and young adults
Cystic fibrosis symptoms in children and young adults may include:

* Salty taste to the skin. People with cystic fibrosis tend to have higher than normal amounts of salt (sodium chloride) in their sweat. This may be one of the first signs parents notice because they can taste the salt when they kiss their child.
* Blockage in the bowels.
* Foul-smelling, greasy stools.
* Delayed growth.
* Thick sputum. It's easy for parents to overlook this sign because young children tend to swallow their sputum rather than cough it up.
* Coughing or wheezing.
* Frequent chest and sinus infections with recurring pneumonia or bronchitis.
* Protrusion of part of the rectum through the anus (rectal prolapse). This is often caused by stools that are difficult to pass or by frequent coughing.
* Enlargement or rounding (clubbing) of the fingertips and toes. Although clubbing eventually occurs in most people with cystic fibrosis, it also occurs in some people born with heart disease and other types of lung problems.

Cystic fibrosis may also be accompanied by:

* Growths (polyps) in the nasal passages.
* Cirrhosis of the liver due to inflammation or obstruction of the bile ducts.
* Displacement of one part of the intestine into another part of the intestine (intussusception) in children older than age 4.

Diagnosis:
Sweat test
The standard diagnostic test for cystic fibrosis is a sweat test, which measures the amount of sodium or chloride in a person's sweat. During the procedure, a small amount of an odorless sweat-producing chemical is applied to a small area on the arm or leg. An electrode attached to the area stimulates a very weak and painless electric current, causing a tingling or warm feeling. After several minutes, sweat is collected from the stimulated area and sent to a laboratory for analysis.

The sweat test is performed on two separate samples, which are usually taken on one occasion, to ensure that a false-positive or false-negative result hasn't occurred. A consistently high level of salt indicates cystic fibrosis. This test doesn't show whether someone has a mild or severe case of the disease, however, and it can't predict how well someone with cystic fibrosis will do.

In addition, the sweat test may not always be useful in newborns. That's because babies may not produce enough sweat for a reliable diagnosis in the first month of life. For this reason, doctors usually don't perform a sweat test until an infant is at least several months old.

Other tests
If your newborn has signs and symptoms of cystic fibrosis, your doctor may perform a genetic analysis of a blood sample to confirm the diagnosis. Tests may also help determine the extent and severity of cystic fibrosis. Among these are tests to measure how well the lungs, pancreas and liver are working.

Because cystic fibrosis is an inherited disease, your doctor may suggest testing the brothers and sisters of a child with cystic fibrosis, even if they show no signs or symptoms. Other family members, especially first cousins, also may want to be tested. In most cases family members can be screened with a sweat test, although in some cases genetic blood testing may be appropriate.

Treatment:
Many treatments exist for the symptoms and complications of cystic fibrosis. The main goal is to prevent infections, reduce the amount and thickness of secretions in the lungs, improve airflow, and maintain adequate calories and nutrition.

To accomplish these objectives, cystic fibrosis treatment may include:

Antibiotics- Newer antibiotics may more effectively fight the bacteria that cause lung infections in people with cystic fibrosis. Among these are aerosolized antibiotics that send medication directly into airways. One of the major drawbacks of long-term use of antibiotics is the development of bacteria that are resistant to drug therapy. In addition, using antibiotics over a long period of time can lead to fungal infections of the mouth, throat and respiratory tract.
Mucus-thinning drugs- When your white blood cells attack bacteria in your airways, DNA in your cells is released, making the mucus in your airways even thicker. The aerosolized drug dornase alfa (Pulmozyme) is an enzyme that fragments DNA, making mucus thinner and easier to cough up. Side effects of the drug may include airway irritation and sore throat.
Bronchodilators- Use of medications such as albuterol, which can be delivered by an inhaler or a nebulizer, may help keep open the bronchial tubes by clearing thick secretions.
Bronchial airway drainage- People with cystic fibrosis need a way to physically remove thick mucus from their lungs. This is often done by manually clapping with cupped hands on the front and back of the chest — a procedure that's best performed with the person's head over the edge of the bed so that gravity helps clear the secretions.

In some cases an electric chest clapper, known as a mechanical percussor, is used. An inflatable vest that vibrates at high frequency also can help people with cystic fibrosis cough up secretions. Many adults and children with pulmonary cystic fibrosis need to have bronchial airway drainage at least twice a day for 20 to 30 minutes. Older children and adults can learn to do this themselves, especially if they use mechanical aids, such as vests and percussors. Young children need the aid of parents, grandparents or older siblings.
Oral enzymes and better nutrition- Cystic fibrosis can cause you to become malnourished because the pancreatic enzymes needed for digestion don't reach your small intestine, preventing food from being absorbed. As a result, you may need many more calories than you otherwise would. Supplemental high-calorie nutrition, special fat-soluble vitamins and enteric-coated oral pancreatic enzymes can help you maintain or even gain weight.
Lung transplantation- Your doctor may suggest lung transplantation if you have severe breathing problems, life-threatening pulmonary complications or increasing resistance to antibiotics used to treat lung infections. Whether you're a good candidate for the procedure depends on a number of factors, including your overall health, certain lifestyle factors and the availability of donor organs. Because both lungs are affected by cystic fibrosis, both need to be replaced. If your chest isn't large enough to hold two adult donor lungs, your surgeon is likely to use two lower lobes contributed by two living donors. However it's performed, lung transplantation is a major operation and may lead to serious complications, especially post-surgical infections.
Pain relievers- Ibuprofen (Advil, Motrin, others) may slow lung deterioration in some children with cystic fibrosis.

Future treatments:
Major progress in cystic fibrosis research came in 1989, when researchers identified the genetic mutation that causes the disease. Since then scientists have been studying ways to insert copies of the normal gene into cells of the respiratory tract.

The challenge has been to find a reliable way to deliver the normal genetic material to affected cells that line the airways. Several methods have been developed as delivery systems, including using modified viruses, fat capsules (liposomes) and synthetic vectors. Clinical trials are under way to test the effectiveness of these delivery systems.

Other research is focusing on modifying the protein that the cystic fibrosis gene produces. This may help normalize the movement of salt and water in and out of the cells.

Cyanosis

Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. It occurs when the oxygen saturation of arterial blood falls below 85-90% (1.5g/dl deoxyhemoglobin). The name is derived from the color cyan, the Greek word for blue.

Although human blood is always a shade of red (except in rare cases of hemoglobin-related disease), the optical properties of skin distort the dark red color of deoxygenated blood to make it appear blueish.

The elementary principle behind cyanosis is that deoxygenated hemoglobin is more prone to the optical bluish discoloration, and also produces vasoconstriction that makes it more evident. The scattering of color that produces the blue hue of veins and cyanosis is similar to the process that makes the sky and large bodies of water appear blue: some colors are refracted and absorbed more than others. During cyanosis, tissues are uncharacteristically low on oxygen, and therefore tissues that would normally be filled with bright oxygenated blood are instead filled with darker, deoxygenated blood. Darker blood is much more prone to the blue-shifting optical effects, and thus oxygen deficiency - hypoxia - leads to blue discoloration of the lips and other mucous membranes.

Types:
Cyanosis can occur in the fingers, including underneath the fingernails, as well as other extremities (called peripheral cyanosis), or in the lips and tongue (central cyanosis).

Central cyanosis is often due to a circulatory or ventilatory problem that leads to poorer blood oxygenation in the lungs or greater oxygen extraction due to slowing down of blood circulation in the skin's blood vessels.

Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest signs that respiration is being blocked.

Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate circulation. The blood reaching the extremities is not oxygen rich and when viewed through the skin a combination of factors can lead to the appearance of a blue color. All factors contributing to central cyanosis can also cause peripheral symptoms to appear, however peripheral cyanosis can be observed without there being heart or lung failures. Small blood vessels may be restricted and can be treated by increasing the normal oxygenation level of the blood.

Causes:
Common causes of central cyanosis- Abnormal hemoglobin levels, Congenital heart disease, Heart failure, Heart valve disease, High altitude, Hypothermia, Hypoventilation, Lung disease, Myocardial infarction, Polycythaemia, Pulmonary embolism, COPD (Emphysema and Chronic Bronchitis), Asthma, Methemoglobinemia, Tetralogy of Fallot (heart defect).

Common causes of acute cyanosis- Choking, Inhaled foreign body, Cold exposure, Drug overdose, Shock, Asthma, Pneumothorax, Heart failure, Left ventricular failure.

Common causes of peripheral cyanosis- All common causes of central cyanosis, Arterial obstruction, Cold exposure (due to vasoconstriction), Raynaud's phenomenon (vasoconstriction), Reduced cardiac output (e.g. heart failure, hypovolaemia), Vasoconstriction, Venous obstruction (e.g. deep vein thrombosis).

Symptoms:
Adult respiratory distress syndrome, Asphyxia, Asthma, Blue baby, Bronchopulmonary dysplasia, Chemical pneumonia, Chronic Bronchitis, Chronic Obstructive Pulmonary Disease, Congenital heart defects, Dermatomyositis, Drowning, Emphysema, Epiglotitis, Erythromelalgia, Familial emphysema, Heart attack, Immune Thrombocytopenic Purpura, Kaposi's Sarcoma,
Melioidosis, Methahemoglobinemia, Mountain sickness, Necrotizing fasciitis, Neonatal Respiratory Distress Syndrome, Pneumoconiosis, Pneumonia, Primary pulmonary hypertension, Pulmonary edema, Pulmonary embolism, Raynaud's phenomenon, Sarcoidosis, Shaken Baby Syndrome, Shock, Whooping Cough.

Diagnosis:

Treatment:

Cushing's Syndrome

Cushing's syndrome is a condition that occurs when your body is exposed to high levels of the hormone cortisol for a prolonged period of time. Sometimes called hypercortisolism, Cushing's syndrome can occur when your adrenal glands, located above your kidneys, make too much cortisol. It may also develop if you're taking high doses of cortisol-like medications (corticosteroids) for a prolonged period.

Too much cortisol can produce some of the hallmark signs of Cushing's syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. It can also result in high blood pressure, bone loss and, on occasion, diabetes.

The most common cause of Cushing's syndrome is the use of oral corticosteroid medication. By contrast, it's rare for the cause to be excess cortisol production by your body. The syndrome is named after Harvey Cushing, an American surgeon who first identified the condition in 1932.

Treatments for Cushing's syndrome are designed to return your body's cortisol production to normal. By normalizing or even markedly lowering cortisol levels, you'll experience noticeable improvements in your signs and symptoms. Left untreated, however, Cushing's syndrome can eventually lead to death.

Causes:
Your endocrine system consists of glands that produce hormones, which regulate processes throughout your body. These glands include the adrenal glands, pituitary gland, thyroid gland, parathyroid glands, pancreas, ovaries (in females) and testicles (in men).

Your adrenal glands produce a number of hormones, including cortisol. Cortisol plays a variety of roles in your body. For example, cortisol helps regulate your blood pressure and keeps your cardiovascular system functioning normally. It also helps your body respond to stress and regulates the way you convert (metabolize) proteins, carbohydrates and fats in your diet into usable energy. However, when the level of cortisol is too high in your body, you may develop Cushing's syndrome.

Cushing's syndrome can develop from a cause that originates outside of your body (Exogenous Cushing's syndrome). Taking corticosteroid medications in high doses over an extended period of time may result in Cushing's syndrome. These medications, such as prednisone, dexamethasone (Decadron) and methylprednisolone (Medrol), have the same effects as does the cortisol produced by your body. People can also develop Cushing's from injectable corticosteroids — for example, repeated injections for joint pain, bursitis and back pain. While certain inhaled steroid medicines (taken for asthma) and steroid skin creams (for skin disorders such as eczema) are in the same general category of drugs, they're generally not implicated in Cushing's syndrome unless taken in very high doses.

The condition may also be due to your body's own overproduction of cortisol (Endogenous Cushing's syndrome). This may occur from excess production by one or both adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which normally regulates cortisol production. In these cases, Cushing's syndrome may be related to:
* A pituitary gland tumor- A noncancerous (benign) tumor of the pituitary gland, located at the base of the brain, secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this form of the syndrome develops, it's called Cushing's disease. It occurs five times as often in women as in men and is the most common form of endogenous Cushing's syndrome.
* An ectopic ACTH-secreting tumor- Rarely, when a tumor develops in an organ that normally does not produce ACTH, the tumor will begin to secrete this hormone in excess, resulting in Cushing's syndrome. These tumors, which can be benign or cancerous (malignant), are usually found in the lung, pancreas, thyroid or thymus gland.
* A primary adrenal gland disease- In some people, the cause of Cushing's syndrome is excess cortisol secretion that doesn't depend on stimulation from ACTH and is associated with disorders of the adrenal glands. The most common of these disorders is a noncancerous tumor of the adrenal cortex, called an adrenal adenoma. Cancerous tumors of the adrenal cortex are rare, but they can cause Cushing's syndrome as well. Occasionally, benign, nodular enlargement of both adrenal glands can result in Cushing's syndrome.

Symptoms:
Common signs and symptoms of Cushing's syndrome include:
* Weight gain, particularly around your midsection and upper back
* Fatigue.
* Muscle weakness.
* Rounding of your face (moon face).
* Facial flushing.
* Fatty pad or hump between your shoulders (buffalo hump).
* Pink or purple stretch marks (striae) on the skin of your abdomen, thighs, breasts and arms.
* Thin and fragile skin that bruises easily.
* Slow healing of cuts, insect bites and infections.
* Depression, anxiety and irritability.
* Thicker or more visible body and facial hair (hirsutism).
* Acne.
* Irregular or absent menstrual periods in females.
* Erectile dysfunction in males.
* High blood pressure.

Diagnosis:
Cushing's syndrome can be difficult to diagnose, particularly endogenous Cushing's, because other conditions share the same signs and symptoms.

Your doctor will conduct a physical exam, looking for signs of Cushing's syndrome. He or she may suspect Cushing's syndrome if you have signs such as rounding of the face (moon face), a pad of fatty tissue at the shoulders and neck (buffalo hump), and thin skin with bruises and stretch marks. Your doctor may ask you about signs and symptoms such as fatigue, depression and weight change.

If you've been taking a corticosteroid medication long term, your doctor may suspect that you've developed Cushing's syndrome as a result of this drug. If you haven't been using a corticosteroid medication, these diagnostic tests may help pinpoint the cause:

Urine and blood tests- These tests measure hormone levels in your urine and blood and show whether your body is producing excessive cortisol. For the urine test, you may be asked to collect a sample of your urine over a 24-hour period. Both the urine and blood samples will be sent to a laboratory to be analyzed for cortisol levels.

Saliva test- Cortisol levels normally rise and fall throughout the day. In people without Cushing's syndrome, levels of cortisol drop significantly overnight. By analyzing cortisol levels from a small sample of saliva collected between 11 p.m. and midnight, doctors can see if cortisol levels are too high, indicating a diagnosis of Cushing's.

Imaging tests- Computerized tomography (CT) scans or magnetic resonance imaging (MRI) scans can provide images of your pituitary and adrenal glands to locate abnormalities, such as tumors.

As these tests help your doctor diagnose Cushing's syndrome, they may also rule out medical conditions with similar signs and symptoms. For example, polycystic ovary syndrome — a hormone disorder in women with enlarged ovaries — shares some of the same signs and symptoms as Cushing's has, such as excessive hair growth and irregular menstrual periods. Depression, eating disorders and alcoholism also can partially mimic Cushing's syndrome.

Treatment:
Treatments for Cushing's syndrome are designed to lower the high level of cortisol in your body. The best treatment for you depends on the cause of the syndrome. Treatment options include:

Reducing corticosteroid use- If the cause of Cushing's syndrome is long-term use of corticosteroid medications, your doctor may be able to keep your Cushing's signs and symptoms under control by reducing the dosage of the drug over a period of time, while still adequately managing your asthma, arthritis or other condition. For many of these medical problems, your doctor can prescribe noncorticosteroid drugs, which will allow him or her to reduce the dosage or eliminate the use of corticosteroids altogether.

Surgery- If the cause of Cushing's syndrome is a tumor, your doctor may recommend complete surgical removal. Pituitary tumors are typically removed by a neurosurgeon, who may perform the procedure through your nose. If a tumor is present in the adrenal glands, lung or pancreas, the surgeon can remove it through a standard operation or in some cases by using minimally invasive surgical techniques, with smaller incisions.

Radiation therapy- If the surgeon can't totally remove the pituitary tumor, he or she will usually prescribe radiation therapy to be used in conjunction with the operation. Additionally, radiation may be used for people who aren't suitable candidates for surgery. Radiation can be given in small doses over a six-week period, or by a technique called stereotactic radiosurgery or gamma-knife radiation.

Medical therapy- In some situations, when surgery and radiation don't produce a normalization of cortisol production, your doctor may advise medical therapy. Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone). Medical therapy is also sometimes used before surgery for people who are very sick. Doing so may improve their signs and symptoms and minimize their surgical risk.

In some cases, the tumor or its treatment will cause other hormones produced by the pituitary or adrenal gland to become deficient and your doctor will recommend hormone replacement medications.

Left untreated, Cushing's syndrome can lead to death. However, most often, treatments improve signs and symptoms and normalize cortisol levels.

Crohns Disease

Crohn's disease, a type of inflammatory bowel disease (IBD), is a condition in which the lining of your digestive tract becomes inflamed, causing severe diarrhea and abdominal pain. The inflammation often spreads deep into the layers of affected tissue. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complication.

While there's no known medical cure for Crohn's disease, therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about a long-term remission. With these therapies, many people afflicted with Crohn's disease are able to function normally in their everyday lives.

Causes:
The exact cause of Crohn's disease is unknown. However, genetic and environmental factors have been invoked in the pathogenesis of the disease. Research has indicated that Crohn's disease has a strong genetic link. The disease runs in families and those with a sibling with the disease are 30 times more likely to develop it than the normal population. Ethnic background is also a risk factor. Until very recently, whites and European Jews accounted for the vast majority of the cases in the United States, and in most industrialized countries, this demographic is still true.

Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn's disease and with susceptibility to certain phenotypes of disease location and activity. In earlier studies, only two genes were linked to Crohn's, but scientists now believe there are over eight genes that show genetics play a crucial role in the disease.

It's possible that a virus or bacterium may cause Crohn's disease. When your immune system tries to fight off the invading microorganism, the digestive tract becomes inflamed. One microorganism that may be involved in the development of Crohn's is Mycobacterium avium subspecies paratuberculosis (MAP), a bacterium that causes intestinal disease in cattle. Researchers have found MAP in the blood and intestinal tissue of many people with Crohn's disease, but only rarely in people with ulcerative colitis.

There's no clear evidence that MAP causes Crohn's disease. Some researchers believe that a genetic susceptibility may trigger an abnormal response to the bacterium in some people. Currently, most investigators believe that some people with the disease develop it because of an abnormal immune response to bacteria that normally live in the intestine.

Symptoms:
Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. They include:

Diarrhea- The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. In mild cases, stools may simply be looser or more frequent than usual. But people with severe disease may have dozens of bowel movements a day, affecting both sleep and ordinary activities.
Abdominal pain and cramping- Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and occur with nausea and vomiting.
Blood in your stool- Food moving through your digestive tract can cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood). In severe disease, bleeding is often serious and ongoing.
Ulcers- Crohn's disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.
Reduced appetite and weight loss- Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
Fistula or abscess- Inflammation from Crohn's disease may tunnel through the wall of the bowel into adjacent organs, such as the bladder or vagina, creating an abnormal connection called a fistula. This can also lead to an abscess, a swollen, pus-filled sore. The fistula may also tunnel out through your skin. A common place for this type of fistula is in the area around the anus. When this occurs, it's called perianal fistula.

Diagnosis:
Blood tests- Your doctor may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with Crohn's disease or ulcerative colitis has these antibodies.
Colonoscopy- This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis.
Flexible sigmoidoscopy- In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last 2 feet of your colon. The test usually takes just a few minutes. It's somewhat uncomfortable, and there's a slight risk of perforating the colon wall. It may also miss problems higher up in your colon or in your small intestine.
Barium enema- This diagnostic test allows your doctor to evaluate your large intestine with an X-ray. Before the test, barium, a contrast dye, is placed into your bowel in an enema form. Sometimes, air also is added. The barium fills and coats the lining of the bowel, creating a silhouette of your rectum, colon and a portion of your small intestine.
Small bowel X-ray- This test looks at the part of the small bowel that can't be seen by colonoscopy. After you drink barium, X-ray pictures are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn's disease.
Computerized tomography (CT)- Sometimes you may have a CT scan, a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel that can't be seen with other tests. Your doctor may order this scan to better understand the location and extent of your disease or to check for complications such as a partial blockages, abscesses or fistulas. Although not invasive, a CT scan exposes you to more radiation than a conventional X-ray does.

Capsule endoscopy- If you have signs and symptoms that suggest Crohn's disease but the usual diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer that you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn's disease. Once it's made the trip through your digestive system, the camera exits your body painlessly in your stool.

Capsule endoscopy is generally very safe, but if you have a partial blockage in the bowel, there's a slight chance the capsule may become lodged in your intestine. Your doctor will try to minimize the chance of this by performing other diagnostic tests to look for a partial blockage before you have this procedure. If the camera does become lodged in the bowel, it may need to be surgically removed.

Treatment:
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

Sulfasalazine (Azulfidine)- Doctors have used this drug for many years to treat Crohn's disease. Although it can be effective in reducing symptoms of the disease, it has a number of side effects, including nausea, vomiting, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.
Mesalamine (Asacol, Rowasa)- This medication tends to have fewer side effects than sulfasalazine has. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected.
Corticosteroids- Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

Immune system suppressors are drugs which reduce inflammation, but they target your immune system rather than treating inflammation itself.
Azathioprine (Imuran) and mercaptopurine (Purinethol)- These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Although it can take up to three months for these medications to begin to work, they help reduce signs and symptoms of IBD in general and can heal fistulas from Crohn's disease in particular. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects.
Infliximab (Remicade)- This drug is specifically for adults and children with moderate to severe Crohn's disease who don't respond to or can't tolerate other treatments. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract and contributes to the formation of fistulas.
Methotrexate (Rheumatrex)- This drug, normally used to treat cancer, is sometimes used for people with Crohn's disease who don't respond well to other medications. It starts working in about eight to 10 weeks. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause allergic pneumonia.
Cyclosporine (Neoral, Sandimmune)- This potent drug, which is most often used to help heal Crohn's-related fistulas, is normally reserved for people who don't respond well to other medications. Cyclosporine begins working in one to two weeks — more quickly than less toxic drugs — but it has the potential for serious side effects, such as kidney and liver damage, high blood pressure, seizures, fatal infections and an increased risk of lymphoma.

Antibiotics can heal fistulas and abscesses in people with Crohn's disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and directly suppress the intestine's immune system, which can trigger symptoms. Frequently prescribed antibiotics include:
Metronidazole (Flagyl)- Once the most commonly used antibiotic for Crohn's disease, metronidazole can sometimes cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. Other side effects include nausea, a metallic taste in your mouth, headache, dizziness and loss of appetite. Avoid alcoholic beverages while taking this medication because a severe reaction may result.
Ciprofloxacin (Cipro)- This drug, which improves symptoms in some people with Crohn's disease, is now generally preferred to metronidazole. Ciprofloxacin may cause fainting, an irregular heartbeat, abdominal pain, diarrhea, fatigue and, rarely, tendon problems.

Coronary heart disease

Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is the leading cause of death in the U.S. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arise. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age.

Overview:
Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of diseases may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in calibre.

Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional angina or decreased exercise tolerance.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

Causes:
Research suggests that coronary artery disease (CAD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

* Smoking
* High amounts of certain fats and cholesterol in the blood
* High blood pressure
* High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack.

Symptoms:
There are often no typical symptoms as they are well known for coronary heart disease; Cardiac Syndrome X often is a diagnosis of exclusion. However, the following list may be helpful in diagnosing the disease:

* Chest pain or Angina, quite often at rest; the pain may spread to the left arm or the neck, back, throat, or jaw. There might be present a numbness (paresthesia) or a loss of feeling in the arms, shoulders, or wrists. Patients with female-pattern coronary artery disease often have chest pain after they exercise and a very variable duration of angina episodes.
* Coronary angiography demonstrates “normal” coronary arteries, i. e. no blockages or stenoses can be detected in the larger epicardial vessels.
* No inducible coronary artery spasm present during cardiac catheterization.
* Characteristic ischemic ECG changes during exercise testing.
* ST segment depression and angina in the absence of left ventricular wall motion abnormalities during pharmacological stress test.
* Reduction of platelet aggregation after exercise (aggregation time 10 seconds).
* Inconstant or partial response to sublingual nitrates.
* Absence of cardiac or systemic diseases potentially associated with microvascular dysfunction.
* Postmenopausal or menopausal status.
* Impaired quality of life.

The diagnosis of “Cardiac Syndrome W” - female-pattern coronary artery disease often is, as mentioned, an “exclusion” diagnosis. Therefore, usually the same tests are used as in any patient with the suspicion of coronary heart disease:

* Baseline ECG
* Exercise ECG – Stress test
* Exercise radioisotope test (nuclear stress test, myocardial scintigraphy).
* Echocardiography (including stress echocardiography).
* Coronary angiography.
* Intravascular ultrasound.
* MRI scan.

Diagnosis:
EKG (Electrocardiogram)- An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart. Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.

Echocardiography- This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray- A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Blood Tests- Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.
Coronary Angiography and Cardiac Catheterization- Your doctor may ask you to have coronary angiography if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries.
Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.

Treatment:
Making lifestyle changes can often help prevent or treat CAD. For some people, these changes may be the only treatment needed:

* Follow a heart healthy eating plan to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight
* Increase your physical activity. Check with your doctor first to find out how much and what kinds of activity are safe for you.
* Lose weight, if you're overweight or obese.
* Quit smoking, if you smoke. Avoid exposure to secondhand smoke.
* Learn to cope with and reduce stress.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can be found on the Nutrition Facts label.

Foods high in soluble fiber also are part of a healthy eating plan. They help block the digestive track from absorbing cholesterol. These foods include:

* Whole grain cereals such as oatmeal and oat bran.
* Fruits such as apples, bananas, oranges, pears, and prunes.
* Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans.

A diet high in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

Fish are an important part of a heart healthy diet. They're a good source of omega-3 fatty acids, which may help protect the heart from blood clots and inflammation and reduce the risk for heart attack. Try to have about two fish meals every week. Fish high in omega-3 fats are salmon, tuna (canned or fresh), and mackerel.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-sodium and low-salt foods and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit alcoholic drinks. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day.

Regular physical activity can lower many CAD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your levels of HDL cholesterol (the "good" cholesterol that helps prevent CAD).

Therapeutic options for coronary heart disease today are based on three principles:

1. Medical treatment- drugs, e.g. nitroglycerin, beta-blockers, calcium antagonists, etc.
2. Coronary interventions as angioplasty and stent-implantation.
3. Coronary artery bypass grafting (CABG - coronary artery bypass surgery). Recent research efforts focus on new angiogenic treatment modalities (angiogenesis) and various (adult) stem cell therapies.

Convulsions

Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many types of seizure, some of which have subtle or mild symptoms instead of convulsions. Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Causes:
Epilepsy, Alcohol use, Barbiturates, intoxication or withdrawal, Brain illness or injury, Brain tumor (rare), Choking, Drug abuse, Electric shock, Fever (particularly in young children),
Head injury, Heart disease, Heat illness, Malignant hypertension (very high blood pressure),
Meningitis, Poisoning, Stroke, Toxemia of pregnancy, Uremia related to kidney failure,
Venomous bites and stings, Withdrawal from benzodiazepines (such as Valium), Low blood sugar, etc.

Considerations:

Convulsions can be unsettling to watch. Despite their appearance, most seizures are relatively harmless. They usually last from 30 seconds to 2 minutes. However, if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, this is a medical emergency.

If a person has recurring seizures, and there are no underlying causes that can be identified, that person is said to have epilepsy. Epilepsy can usually be controlled well with medication.

Pay attention to which arms or legs are shaking, whether there is any change in consciousness, whether there is loss of urine or stool, and whether the eyes deviate in any direction.

Symptoms:
Brief blackout followed by period of confusion, Sudden falling, Drooling or frothing at the mouth,
Grunting and snorting, Breathing stops temporarily, Uncontrollable muscle spasms with twitching and jerking limbs, Loss of bladder or bowel control, Eye movements, Teeth clenching, Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing, The person may have warning symptoms prior to the attack, which may consist of fear or anxiety, nausea, visual symptoms, or vertigo.

First Aid:
1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
5. Look for a medical I.D. bracelet with seizure instructions.
6. Stay with the person until recovery or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child acetaminophen (Tylenol), especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath.

Do Not:
* DO NOT restrain the person.
* DO NOT place anything between the person's teeth during a seizure (including your fingers).
* DO NOT move the person unless he or she is in danger or near something hazardous.
* DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is not aware of what is happening at the time.
* DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Constipation

Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. It may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation that prevents passage of both stools and gas. Causes of constipation may be dietary, hormonal, anatomical, a side effect of medications (e.g. some painkillers), or an illness or disorder. Treatments consist of changes in dietary and exercise habits, the use of laxatives, and other medical interventions depending on the underlying cause.

Causes:
The main causes of constipation include:

* Hardening of the feces
Improper mastication (chewing) of food.
Insufficient intake of dietary fiber.
Dehydration from any cause or inadequate fluid intake.
Medication, e.g. diuretics and those containing iron, calcium, aluminum.
Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along.
Hypothyroidism (slow-acting thyroid gland).
Hypokalemia.
Injured anal sphincter (patulous anus).
Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants.
* Severe illness due to other causes
Acute porphyria (a rare inherited condition).
Lead poisoning.
* Dyschezia (usually the result of suppressing defecation).
* Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass
Stenosis (Strictures).
Diverticula.
Tumors, either of the bowel or surrounding tissues.
Retained foreign body or a bezoar.
* Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
Functional constipation.
Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain.
* Smoking cessation (nicotine has a laxative effect).
* Abdominal surgery, other types of surgery, childbirth.

Symptoms:
Following are the major constipation symptoms:

1. Difficulty in elimination of the hard faecal matter.
2. Cramping in a lower abdomen.
3. Mouth ulcer.
4. Bad breath.
5. Nausea.
6. Headache.
7. Coated tongue.
8. Dullness on skin.

Diagnosis:
The diagnosis is essentially made from the patient's description of the symptoms। Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.

During physical examination, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.

X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms।

Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation।

Treatment:
In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.

Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. hyponatremia may occur in some cases especially in diabetics.

In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter.

Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli.

Conjunctivitis

Conjunctivitis, commonly called "Pink Eye" and "Red Eye" in the UK, and "Madras Eye" in India is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually bacterial, or viral).

Pink eye may make you feel as if you've got something in one or both of your eyes that you just can't remove. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes. The whites of your eyes may begin to have a pink discoloration, and you may not see as clearly as you did before.
Inflammation causes small blood vessels in the conjunctiva to become more prominent, resulting in a pink or red cast to the whites of your eyes. Pink eye and red eye are terms commonly used to refer to all types of conjunctivitis. Though the inflammation of pink eye makes it an irritating condition, it rarely affects your sight. If you suspect pink eye, you can take steps to ease your discomfort. But because pink eye can be contagious, it should be diagnosed and treated early. This is especially important for preschool-age children, who commonly develop both viral and bacterial conjunctivitis.


Types:

Blepharoconjunctivitis is a combination of conjunctivitis with blepharitis (inflammation of the eyelids).
Keratoconjunctivitis is a combination of conjunctivitis and keratitis (corneal inflammation).
Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing.

Causes:
Causes of pink eye include:

* Viruses.
* Bacteria.
* Allergies.
* A chemical splash in the eye.
* A foreign object in the eye.

Most cases of pink eye are caused by viruses. In newborns, pink eye may result from an incompletely opened tear duct.

Viral and bacterial conjunctivitis may affect one or both eyes. Viral conjunctivitis usually produces a watery or mucous discharge.
Bacterial conjunctivitis often produces a thicker, yellow-green discharge and may be associated with a respiratory infection or with a sore throat. Both viral and bacterial conjunctivitis are associated with colds. Both viral and bacterial types are very contagious. Adults and children alike can develop both of these types of pink eye. However, bacterial conjunctivitis is more common in children than it is in adults.

Allergic conjunctivitis affects both eyes and is a response to an allergy-causing substance such as pollen. In response to allergens, your body produces an antibody called immunoglobulin E (IgE). This antibody triggers special cells called mast cells in the mucous lining of your eyes and airways to release inflammatory substances, including histamines. Your body's release of histamine can produce a number of allergy symptoms, including red or pink eyes. If you have allergic conjunctivitis, you may experience intense itching, tearing and inflammation of the eyes — as well as itching, sneezing and watery nasal discharge. You may also experience swelling of the membrane (conjunctiva) that lines your eyelids and part of your eyeballs, resulting in what may look like clear blisters on the whites of your eyes.

Irritation from a chemical splash or foreign object in your eye is also associated with conjunctivitis. Discharge tends to be mucus, not pus. Sometimes, flushing and cleaning the eye to rid it of the chemical or object causes redness and irritation. Signs and symptoms usually clear up on their own within about a day.

Symptoms:
The most common signs and symptoms of pink eye include:

* Redness in one or both eyes
* Itchiness in one or both eyes
* Blurred vision and sensitivity to light
* A gritty feeling in one or both eyes
* A discharge in one or both eyes that forms a crust during the night
* Tearing

Acute allergic conjunctivitis is typically itchy. Sometimes distressingly so, and the patient often complains of some lid swelling. Chronic allergy often causes just itch or irritation, and often much frustration because the absence of redness or discharge can lead to accusations of hypochondria.
Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the fellow eye.
Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge that may cause the lids to stick together (matting), especially after sleeping.
Irritant or toxic conjunctivitis is irritable or painful when the infected eye is pointed far down or far up. Discharge and itch are usually absent. This is the only group in which severe pain may occur.

Diagnosis:
Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicroscopy, laboratory tests are often necessary if proof of aetiology is needed.
A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious.
A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.
Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.
Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.
Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula.

Treatment:
Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.
Your doctor may prescribe antibiotic eyedrops if the infection is bacterial, and the infection should clear within several days of starting treatment. Antibiotic eye ointment, in place of eyedrops, is sometimes prescribed for treating bacterial pink eye in children. An ointment is often easier to administer to an infant or young child than are eyedrops.

Congestive heart failure

Congestive heart failure (CHF), congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body. It is not to be confused with "cessation of heartbeat", which is known as asystole, or with cardiac arrest, which is the "cessation of normal cardiac function" with subsequent hemodynamic collapse leading to death.

Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.

The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Causes:
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:

Coronary artery disease and heart attack- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.

High blood pressure (hypertension)- Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves- The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy)- Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis- Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects)- If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias)- Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases- Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Symptoms:

Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.

Some of the signs and symptoms for chronic and acute heart failure are:

Chronic heart failure- Fatigue and weakness, Rapid or irregular heartbeat, Shortness of breath (dyspnea) when you exert yourself or when you lie down, Reduced ability to exercise, Persistent cough or wheezing with white or pink blood-tinged phlegm, Swelling (edema) in your legs, ankles and feet, Swelling of your abdomen (ascites), Sudden weight gain from fluid retention, Lack of appetite and nausea, Difficulty concentrating or decreased alertness, etc.

Acute heart failure- Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly, Sudden fluid buildup, Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating, Sudden, severe shortness of breath and coughing up pink, foamy mucus, Chest pain if caused by a heart attack, etc.

Diagnosis:
To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination.

Blood tests- Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it's injured or overworked.
Chest X-ray- X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
Electrocardiogram (ECG)- This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Echocardiogram- An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart's main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
Ejection fraction- Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.
Other imaging tests- They may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).

Treatment:
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:

Angiotensin-converting enzyme (ACE) inhibitors- These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
Angiotensin II (A-II) receptor blockers (ARBs)- These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
Digoxin (Lanoxin)- This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
Beta blockers- This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms.
Diuretics- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Aldosterone antagonists- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They're primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer.

***A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure.***

Surgery and medical devices:
Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:

Implantable cardioverter-defibrillators (ICDs)- An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
Cardiac resynchronization therapy (CRT) or biventricular pacing- A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
Heart pumps- These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.